Spontaneous Renal Cholesterol Crystal Embolism in a Patient with Functionally Solitary Kidney

Abstract

Renal cholesterol crystal embolism (also called renal atheroembolism) is a cause of acute kidney injury with increasing frequency. It is usually seen in patients older than 60 years of age with diffuse atherosclerotic disease. Although it develops usually following vascular interventions; it may occur spontaneously. It presents with partial or total occlusion of small arteries due to distal embolization from cholesterol crystals from ruptured atherosclerotic plaques. It is in fact a part of systemic disease called cholesterol crystal embolization disease affecting kidneys, eyes, brain and gastrointestinal system. Livedo reticularis, especially purple discoloration of toes are clues for diagnosis. The pathognomonic finding of renal cholesterol crystal embolism is the cholesterol crystal clefts in renal biopsy specimen. Herein, we present a atypical case of acute kidney injury due to spontaneous cholesterol crystal embolization in a patient with functionally solitary kidney.

Keywords

• Acute kidney injury, atheroembolic disease, renal cholesterol crystal embolism

Spontaneous Renal Cholesterol Crystal Embolism in a Patient with Functionally Solitary Kidney

Öz

Renal kolesterol kristal embolizimi (renal ateroembolizim) akut böbrek hasarının artan nedenlerinden biridir. Genellikle yaygın aterosklerozu olan 60 yaşının üzerindeki hastalarda görülmektedir. Vasküler girişimler sonrasında ortaya çıkabileceği gibi spontan olarak da meydana gelebilir. Rüptüre aterosklerotik plaklardan serbestleşen kolesterol kristallerinin distaldeki küçük arterleri total yada parsiyel olarak tıkaması sonucu ortaya çıkmaktadır. Aslında sistemik bir hastalık olan, böbrekler, gözler, beyin ve gastrointestinal sistemi tutabilen kolesterol kristal embolizimi hastalığının bir parçasıdır. Livedo retikülaris ve ayak parmaklarında mor renk değişiklikleri hastalığın ipuçları olabilir. Renal kolesterol kristal emboliziminin patognomonik bulgusu böbrek biyopsisinde kolesterol kleftlerinin gösterilmesidir. Bu yazıda fonksiyonel olarak tek böbrekli bir hastada spontan kolesterol kristal embolisine bağlı gelişen bir akut böbrek hasarı olgusu sunduk

Anahtar Kelimeler

• Akut böbrek hasarı, atheroembolik hastalık, renal kolesterol kristal embolisi

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